Prior use of statins and outcome in patients with intracerebral haemorrhage

Background:  Pre-treatment with cholesterol lowering drugs of the statin family may exert protective effects in patients with ischaemic stroke and subarachnoid haemorrhage but their effects are not clear in patients with intracerebral haemorrhage (ICH).
Methods:  We recruited patients admitted to our University Hospital with an acute ICH and analysed pre-admission demographic variables, pre-morbid therapy, clinical and radiological prognostic markers and outcome variables including 90-day modified Rankin score and NIH stroke scale score (NIHSS).
Results:  We recruited 399 patients with ICH of which 101 (25%) were using statins. Statin users more often had vascular risk factors, had significantly lower haematoma volumes ( P  = 0.04) and had lower mortality rates compared with non-users (45.6% vs. 56.1%; P  = 0.11). However, statin treatment did not have a statistically significant impact on mortality or functional outcome on multiple logistic regression analysis.
Conclusions:  Treatment with statins prior to ICH failed to show a significant impact on outcome in this analysis despite lower haematoma volumes.     

Surgery for patients with severe supratentorial intracerebral hemorrhage

Introduction  Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH. Methods  We studied 103 consecutive patients who were admitted to the intensive care unit and diagnosed with primary supratentorial ICH. The impacts of clinical factors on 30-day mortality were assessed, including surgery, Glasgow Coma Scale (GCS) score and pupillary abnormality at admission, hematoma volume, and other related factors. Results  The 30-day mortality rate was 42%, and the median time between admission and death was 3 days (range: 1 to 27 days). Hematoma removal and ventricular drainage, within the first 24 hours of admission, were performed on 11 and 17 patients, respectively. Two patients who were treated with removal and four with drainage died. A logistic regression model for predicting 30-day mortality was performed. After controlling for GCS score, pupillary abnormality, hydrocephalus, and hematoma volume, hematoma removal was identified as an independent predictor of survival (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02 to 0.92). Ventricular drainage also tended to decrease mortality rate greatly (OR, 0.31; 95% CI, 0.06 to 1.76). Patients with GCS scores of 3 or 4 were 4.01 times more likely to die (95% CI, 1.13 to 14.26) than those with GCS of at least 5. Conclusions  Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.     

Abnormalities on ECG and telemetry predict stroke outcome at 3 months

BACKGROUND: ECG is a useful tool in monitoring vital functions in patients with acute stroke; however, fairly little evidence is available concerning the prevalence and the prognostic impact of ECG findings in patients with acute cerebral infarction and acute intracerebral haemorrhage (ICH). METHODS: This analysis was based on data from 692 patients with acute cerebral infarction, 155 patients with intracerebral haemorrhage (ICH), and 223 patients with transient ischaemic attack (TIA), who were admitted to hospital within 6 h of symptom onset. A 12 lead ECG was obtained on admission, and the patient was on telemetry for the first 12-24 h of hospitalisation. RESULTS: ECG abnormalities were observed in 60% of patients with cerebral infarction, 50% of patients with ICH, and 44% of patients with TIA. In multivariate analyses 3-month mortality in patients with ischaemic stroke was predicted by atrial fibrillation OR 2.0 (95% CI 1.3-3.1), atrio-ventricular block OR 1.9 (95% CI 1.2-3.9), ST-elevation OR (2.8, 95% CI 1.3-6.3), ST-depression OR 2.5 (95% CI 1.5-4.3), and inverted T-waves OR 2.7 (95% CI 1.6-4.6). This was independent of stroke severity, pre-stroke disability and age. In patients with ICH, sinus tachycardia OR 4.8 (95% CI 1.7-14.0), ST-depression OR 5.2 (95% CI 1.1-24.9), and inverted T-wave 5.2 (95% CI 1.2-22.5) predicted poor outcome. None of the changes reached significance in patients with TIA. In patients with severe cerebral infarction or ICH, heart rate did not decrease within the first 12 h after admission, which was the case in patients with mild to moderate stroke. Rapid heart rate predicted 3-month mortality in multivariate testing OR 1.7 (95% CI 1.02-2.7). CONCLUSIONS: ECG abnormalities are frequent in acute stroke and may predict 3-month mortality.     

Intracerebral haemorrhage in a population-based stroke registry (LuSSt): incidence, aetiology, functional outcome and mortality

Data on incidence of intracerebral haemorrhage (ICH) vary widely. Population-based data on predictors of ICH survival and functional outcome are rare. The Ludwigshafen Stroke Study is a prospective, population-based stroke registry which started in January 2006. All residents of the city of Ludwigshafen, Germany, who suffer from acute stroke or transient ischaemic attack are registered. Patients with first-ever primary intracerebral haemorrhage (FE-pICH) between 2006 and 2010 were included in the present analysis. Between January 1st, 2006 and December 31st, 2010, 152 patients suffered a FE-pICH. Crude and age-adjusted incidence rates per 100,000 for FE-pICH were 18.7 (95 % CI 15.9–21.9) and 11.9 (95 % CI 10.2–14.0), respectively, and remained stable over time. Case-fatality rates for FE-pICH were 27.0, 34.9 and 44.1 % at days 28, 90 and 365, respectively. In 21 patients, an (21.3 %) early do-not resuscitate-order was documented. Excluding these patients from multivariate analyses, National Institute of Health Stroke Scale (NIHSS) (OR 1.22, 95 % CI 1.08–1.36), hypercholesterolemia (OR 0.16, 95 % CI 0.05–0.55) and modified Rankin Scale (mRS) prior to stroke (OR 1.56, 95 % CI 1.06–2.3) were independently associated with risk of 1-year mortality, whereas NIHSS (OR 1.41, 95 % CI 1.20–1.66) and leukocyte count on admission (OR 1.48, 95 % CI 1.16–1.89) were independently associated with good or moderate functional outcome (mRS ≤ 3) after 1 year. Incidence of FE-ICH is in the lower range of those reported from other registries and remained stable over the observation period. Higher treatment rates for hypertension might partly account for this. Stroke severity as indicated by NIHSS was independently associated with mortality and functional outcome after 1 year. We found no association between aetiology and outcome in ICH patients.     

High‐dose statin therapy and risk of intracerebral hemorrhage: a meta‐analysis

Statin plays a major role in the primary and secondary prevention of cardiovascular disease (CVD). Inconsistent findings in the studies have been observed toward the risk of intracerebral hemorrhage (ICH) using higher dose of statin. To examine this issue, we performed a meta‐analysis of randomized controlled trials (RCTs) to assess the association between higher dose of various statins and risk of ICH among patients with CVD. Literature was searched for studies published before June 10, 2015, using electronic database ‘PubMed’, ‘EMBASE’, and ‘Google Scholar’ as well as from many trial databases. The following search terms were used: ‘Statin therapy’ AND ‘Cardiovascular Disease’, AND ‘Dose’ AND ‘Intracerebral hemorrhage’, AND ‘Randomized Controlled Trials’ AND ‘High Dose Statin’. High dose of statins was defined as atorvastatin 80 mg, simvastatin 80 mg, pravastatin 40 mg, rosuvastatin 20 mg per day. Fixed‐effect model was used to estimate the risk ratio (RR) and 95% confidence interval (CI) if heterogeneity was <50%; otherwise, random‐effect model was used. Begg's funnel plot was used to assess the publication bias. Seven RCTs involving 31,099 subjects receiving high‐dose statin and 31,105 subjects receiving placebo were analyzed in our meta‐analysis. A significant risk of ICH was observed in subjects with higher dose of statin (RR = 1.53; 95% CI: 1.16–2.01; P = 0.002). There was no difference in all‐cause mortality between the two groups (RR = 0.95; 95% CI: 0.86–1.06; P = 0.36). No publication bias was observed through Begg's funnel plot. Higher dose of statins was found to be associated with the risk of ICH. Future studies are needed to confirm these findings.     

Serum D-dimer as a predictor of mortality in patients with acute spontaneous intracerebral hemorrhage

It has been found that the hemostatic system is activated following a brain injury. To explore the role of D-dimer in spontaneous intracerebral hemorrhage (ICH), this prospective study aimed to evaluate the association between serum D-dimer concentration, clinical outcome and radiographic findings of ICH patients in the emergency department (ED). Patients with acute (<24 hours) spontaneous ICH were enrolled in this study. The D-dimer concentration was related to: baseline ICH volume (r=0.198, p=0.01); Glasgow Coma Scale (GCS) score 3-8 (p=0.01); GCS score 13-15 (p=0.002); midline shift >15 mm (p=0.016); and to subarachnoid extension of the blood (p<0.0001). Diabetes mellitus (odds ratio [OR]: 2.93; 95% confidence interval [CI]: 1.1-7.76, p=0.031), ICH volume (OR: 1.16; 95% CI: 1.07-1.27, p<0.0001) and D-dimer concentration (OR: 2.72; 95% CI: 1.08-6.9, p=0.002) were associated with 30-day mortality. This study shows that in patients with spontaneous ICH, a higher initial D-dimer concentration is associated with higher 30-day mortality.     

Lipid profile,statin use,and outcome after intravenous thrombolysis for acute ischaemic stroke

BACKGROUND: Low cholesterol levels have been associated with an increased risk of haemorrhagic stroke. This study investigated whether lipid levels or prior statin use influence outcome in patients with acute ischaemic stroke treated with IV thrombolysis. METHODS: The relation between admission lipid levels or statin use and both the development of symptomatic intracerebral haemorrhage (sICH) and 3-months functional outcome was assessed in a prospective hospital-based stroke registry comprising 252 patients treated with IV tissue plasminogen activator (tPA). The fasting status of the patients was unknown. Favourable outcome at 3 months was defined as a modified Rankin scale score 相似文献   

tPA treatment for acute ischaemic stroke in patients with leukoaraiosis

Background and Purpose: Whether leukoaraiosis on baseline CT is associated with an increased risk of symptomatic intracerebral haemorrhage (sICH) or poor outcome following tissue plasminogen activator (tPA) treatment for acute ischaemic stroke is still a matter of debate. Objective: To investigate the relationship between the presence and severity of leukoaraiosis on baseline CT and the risk of sICH and functional outcome after tPA treatment for acute ischaemic stroke. Methods: A single‐center observational cohort study with a retrospective analysis on consecutive patients with ischaemic stroke treated with tPA in the period 2002–2008. Outcome measures were the occurrence of sICH and functional outcome at 3 months. Results: Of the 400 patients, 24% had leukoaraiosis on their baseline CT. Eleven patients (11%) with leukoaraiosis versus thirteen (4%) patients without leukoaraiosis had a sICH [odds ratio (OR) 2.85 95%‐CI 1.23–6.60, P = 0.02]. Multivariate analysis showed a non‐significant trend towards an association of leukoaraiosis and sICH (OR 1.9, 95%‐CI 0.78–4.68, P = 0.16). Leukoaraiosis was independently associated with poor functional outcome (OR 2.39, 95%‐CI 1.21–4.72, P = 0.01). No difference was observed in the outcome measures amongst patients with moderate or severe leukoaraiosis. Conclusion: Our study demonstrates that patients treated with tPA and leukoaraiosis on their baseline CT are at greater risk of sICH and have a worse functional outcome compared to patients without leukoaraiosis. It is important to note that these results should not lead to exclusion of patients with leukoaraiosis for tPA treatment.     

Effect of previous statin therapy on severity and outcome in ischemic stroke patients: a population-based study

Although statin therapy has been shown to be effective in the prevention of ischemic stroke, its effect on stroke severity and early outcome is still controversial. We aimed to evaluate the association between statin use before onset and both initial severity and functional outcome in ischemic stroke patients. All cases of first-ever ischemic stroke that occurred in Dijon, France (151,000 inhabitants) between 2006 and 2011 were prospectively identified from the Dijon Stroke Registry. Vascular risk factors, clinical severity at onset assessed by the NIHSS score, stroke subtypes, prestroke statin use, and lipid profile were collected. Functional outcome was defined by a six-level categorical outcome using the modified Rankin scale. Analyses were performed using ordinal logistic regression models. Among the 953 patients with first-ever ischemic stroke, 127 (13.3 %) had previously been treated with statins. Initial stroke severity did not differ between statin users and non-users [median NIHSS score (interquartile range) 4.0 (7.0) versus 4.0 (9.0) p = 0.104]. In unadjusted analysis, statin use was associated with a lower risk of an unfavorable functional outcome at discharge (OR 0.69; 95 % CI 0.49–0.96; p = 0.026) that was no longer significant in multivariate analyses (OR 0.76; 95 % CI 0.53–1.09; p = 0.134). After adjustment for admission plasma LDL cholesterol levels, the non-significant association was still observed (OR 0.76; 95 % CI 0.49–1.18; p = 0.221). This population-based study showed that prestroke statin therapy did not affect initial clinical severity but was associated with a non-significant better early functional outcome after ischemic stroke.     

Effect of statin treatment on three-month outcomes in patients with stroke-associated infection: a prospective cohort study

Background and purpose: Infection is a major medical problem in patients with acute stroke. Recent evidences suggest that statins reduce infection‐associated complications. The purpose of this study was to examine the influence of statin treatment on mortality and functional outcomes in patients with stroke‐associated infection. Methods: In this prospective observational cohort study, 514 patients with acute ischaemic stroke or transient ischaemic attack (mean age, 74 ± 11 years; men, 48%) with infection occurring in the first 7 days after admission were included. We examined the effect of in‐hospital statin treatment on mortality and favorable functional outcome (modified Rankin Scale score ≤2) at 3 months follow‐up. Results: Infection occurred at 0.93 ± 1.49 days after admission. All patients had not received statin treatment prior to admission, and 121 patients (24%) received statin at 1.71 ± 1.28 days after admission. Follow‐up at 3 months was completed for 511 patients (99%). National Institutes of Health Stroke Scale score and Charlson index were the most important independent predictors of mortality and functional outcome. Univariate [hazard ratio (HR), 0.82; 95% confidence intervals (CI), 0.47–1.42] and multivariate (HR, 1.68; 95% CI, 0.79–3.56) Cox regression analysis showed that statin did not significantly decrease the morality. In propensity analysis, statin treatment still had no significant association with mortality (HR, 1.54; 95% CI, 0.68–3.47) in the multivariate analyses after adjusting for age, sex, and propensity score. Conclusions: Statin use was not associated with a better functional outcome or survival in patients with stroke‐associated infection.     

Brain herniations in patients with intracerebral hemorrhage

Objectives – To study the types, frequency and clinical correlates of brain herniations in patients with intracerebral hemorrhage (ICH). Methods – In 24 patients with ICH (putaminal 22 and thalamic 2) features of raised intracranial pressure (ICP), such as hyperventilation, extensor rigidity, pupillary asymmetry and pyramidal signs on the non‐hemiplegic side, were recorded. Depth of coma was assessed by using the Glasgow Coma Scale (GCS) and severity of stroke by using the Canadian Neurological Scale (CNS). On MRI, evidence of herniation, horizontal and vertical shifts and the edema–hematoma complex were measured and compared with that of 15 matched controls. The clinical signs of herniation correlated with radiological parameters. Results – The mean age of the patients was 57.7 years, six of them were women. Cerebral herniations were present in 11 (46%) patients. Subfalcian herniation (in six) was the commonest followed by uncal (in three). Combination of subfalcian and uncal herniations was present in one and subfalcian, uncal and tonsillar herniations in another. Herniations had significant correlation with the GCS, pupillary abnormalities, cortical atrophy, hematoma size and the edema–hematoma complex. One‐month mortality was related to the GCS score, pupillary abnormalities and the edema–hematoma complex. Horizontal shift was related to the GCS score. Conclusion – In patients with ganglionic ICH, subfalcian herniation was the commonest. Herniation was associated with increased mortality. Horizontal shift correlated with clinical features of raised ICP and outcome.     

Prior Statin Use Reduces Mortality in Intracerebral Hemorrhage

Objective  To assess the impact of blood glucose, coagulopathy, seizures and prior statin and aspirin use on clinical outcome following intracerebral hemorrhage (ICH). Background  Intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes with mortality rates approaching 50%. Glasgow Coma Scale (GCS), ICH volume, age, pulse pressure, ICH location, intraventricular hemorrhage (IVH) and hydrocephalus are known to impact 30-day survival following ICH and are included in various prediction models. The role of other clinical variables in the long-term outcome of these patients is less clear. Methods  Records of consecutive ICH patients admitted to The Johns Hopkins Hospital from 1999 to 2006 were reviewed. Patients with ICH related to trauma or underlying lesions (e.g. brain tumors, aneurysms, arterio-venous malformations) and of infratentorial location were excluded. The impact of admission blood glucose, coagulopathy, seizures on presentation and prior statin and aspirin use on 30-day mortality and functional outcomes at discharge was assessed using dichotomized Modified Rankin Scale (dMRS) and Glasgow Outcomes scale (dGOS). Other variables known to impact outcomes that were included in the multiple logistic regression analysis were age, admission GCS, pulse pressure, ICH volume, ICH location, volume of IVH and hydrocephalus. Results  A total of 314 patients with ICH were identified, 125 met inclusion criteria. Patients’ age ranged from 34 to 90 years (mean 63.5), 57.6 % were male. Mean ICH volume was 32.09 cc (range 1–214 cc). Following multiple logistic regression analysis, prior statin use (P = 0.05) was found to be associated with decreased mortality with a greater than 12-fold odds of survival while admission blood glucose (P = 0.023) was associated with increased 30-day mortality. Coagulopathy, seizures on presentation, and prior aspirin use had no significant impact on 30-day mortality or outcomes at discharge in our study cohort. Conclusions  The significant association of prior statin use with decreased mortality warrants prospective evaluation of the use of statins following ICH.     

Natural history of complications after intracerebral haemorrhage

Background and purpose:  Numerous trials of haemostatic and neuroprotective agents for intracerebral haemorrhage (ICH) have failed. We characterized the risk of complications after ICH in a trial-eligible patient population, to inform safety in future trials.
Methods:  We used the Virtual International Stroke Trials Archive database to identify placebo-treated patients with spontaneous ICH, who were not comatose at admission, where randomization took place within 4 h of symptom onset, and where serious complication and outcome data were available. We described the complications encountered and assessed whether the absence of common complications influenced attainment of good functional outcome (mRS ≤4) at 90 days using logistic regression.
Results:  Of 201 patients examined, 70.2% experienced at least one serious complication. Neurological complications occurred in 21%, infections amongst 11%, and thromboembolic complications in 2%. Extension of the haemorrhage occurred most frequently: its absence was a significant predictor of good functional outcome ( P  < 0.0001, adjusted OR for good functional outcome = 21.9, 95% CI: [5.5, 88.3]). Neither infection, nor cardiac, nor thromboembolic complications influenced functional outcome at 90 days.
Conclusions:  Three month outcome in ICH patients depends on initial stroke severity and on enlargement of the haemorrhage. Our results should inform safety in future clinical trials of putative ICH therapies.     

Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma : protocol and preliminary experience

BACKGROUND AND PURPOSE: We review preliminary experience with patients harboring intracerebral hematoma (ICH) treated by stereotactic computed tomographic (CT) guided thrombolysis and aspiration and assess procedure feasibility and safety. METHODS: Twelve patients with supratentorial ICH >/=25 mL without suspected underlying structural etiology or coagulopathy and an initial Glasgow Coma Scale (GCS) score of >/=5 were treated. A catheter was directed stereotactically or manually into the ICH through a burr hole under CT guidance. Hematoma aspiration was followed by instillation of urokinase (5 000 to 10 000 IU). This was repeated every 6 to 8 hours at bedside, with interval CT imaging, until the ICH volume diminished to <25 mL, less than half of its initial volume, or after a maximum of 10 aspirations/instillations. RESULTS: Mean age was 69 years (range 55 to 82 years). Median initial GCS was 12 (range 5 to 14). There were 7 ganglionic and 5 lobar ICH, and baseline hematoma size ranged 29 to 70 mL (mean 46 mL). Final ICH volume ranged from 14 to 51 mL (mean 21 mL), with ICH volume reduction by an average of 57% (range 38% to 70%). One patient (8. 3%) suffered hematoma expansion during the procedure. At 6 months after the procedure, 3 patients (25%) had achieved a good recovery (Glasgow Outcome Scale [GOS] score of 5), 5 patients (42%) were dependent (GOS 3), and 1 (8.3%) remained vegetative (GOS 2). Three patients (25%) died in hospital (1 from cardiac arrhythmia and 2 from respiratory failure). CONCLUSIONS: CT-guided thrombolysis and aspiration appears safe and effective in the reduction of ICH volume. Further studies are needed to assess optimal thrombolytic dosage and must include controlled comparisons of mortality, disability outcome, time until convalescence, and cost of care in treated and untreated patients.     

脑出血急性期合并脑梗死的危险因素分析

目的 探讨脑出血急性期合并脑梗死的危险因素。方法 按照发病后2周内弥散加权成像(diffusion weighted image,DWI)上是否有新的脑梗死灶将125例原发性脑出血患者分为2组,比较临床资料的差异。结果 21例DWI阳性者脑叶出血发生率、颅内大动脉狭窄发生率、平均血肿体积显著高于38例DWI阴性者(P<0.05)。Logistic回归分析显示入院第1 d平均动脉压降低幅度(OR=7.384,P<0.001)、脑叶出血(OR=3.124,P=0.021)及颅内大动脉狭窄(OR=5.044,P=0.027)与脑出血急性期合并新发脑梗死灶呈正相关。结论 平均动脉压降低幅度、脑叶出血、颅内大动脉狭窄可增加脑出血急性期合并急性脑梗死的风险。     

Clinical application of 3DSlicer and Sina in minimally invasive puncture drainage of elderly patients with spontaneous intracerebral hemorrhage under local anesthesia

BackgroundDecreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)–guided stereotactic localization of hematomas in elderly patients diagnosed with ICH.MethodsThe study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups.ResultsNo significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05).ConclusionsA combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.     

Effects of statin and deferoxamine administration on neurological outcomes in a rat model of intracerebral hemorrhage

Deferoxamine (DFX), a potent iron-chelating agent, reduces brain edema and neuronal cell injury that develop due to the hemolysis cascade. Statins have neuroprotective effects via anti-inflammatory action and increment of cerebral blood flow after intracerebral hemorrhage (ICH). The purpose of this study was to identify the effects of combined DFX and statins treatment in an experimental ICH rat model. The treatments were: intraperitoneal (i.p.) injection of DFX (group I), combined treatment of i.p. DFX and oral statins (group II), statins only (group III) and treatment with vehicle (group IV). Induction of ICH was performed with injection of bacterial collagenase type IV into the left striatum. After removal of the brain, hematoma volume, water content and brain atrophy were measured. Immunohistochemistry in the perihematomal region was performed for identification of microglial infiltration, astrocyte expression and apoptotic cell presence. Statistical analysis was performed using the non-parametric Kruskal–Wallis test and significance was evaluated when the p value was less than 0.05. According to behavioral tests, significant differences among treatment groups were noted 4 weeks after ICH induction (p < 0.05). However, there were no significant differences among treatment groups in hematoma volume, brain water content or brain atrophy. In the perihematomal area, the activated microglial cells were reduced in the combined treatment group. Among the four groups, a significant difference in immunohistochemical staining was identified (p < 0.05). These results suggest that combined treatment with DFX and statins improves neurologic outcomes after ICH through reduction of microglial infiltration, apoptosis, inflammation and brain edema.     

Perihematoma cerebral blood flow is unaffected by statin use in acute intracerebral hemorrhage patients

Statin therapy has been associated with improved cerebral blood flow (CBF) and decreased perihematoma edema in animal models of intracerebral hemorrhage (ICH). We aimed to assess the relationship between statin use and cerebral hemodynamics in ICH patients. A post hoc analysis of 73 ICH patients enrolled in the Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT). Patients presenting <24 hours from ICH onset were randomized to a systolic blood pressure target <150 or <180 mm Hg with computed tomography perfusion imaging 2 hours after randomization. Cerebral blood flow maps were calculated. Hematoma and edema volumes were measured planimetrically. Regression models were used to assess the relationship between statin use, perihematoma edema and cerebral hemodynamics. Fourteen patients (19%) were taking statins at the time of ICH. Statin-treated patients had similar median (IQR Q25 to 75) hematoma volumes (21.1 (9.5 to 38.3) mL versus 14.5 (5.6 to 27.7) mL, P=0.25), but larger median (IQR Q25 to 75) perihematoma edema volumes (2.9 (1.7 to 9.0) mL versus 2.2 (0.8 to 3.5) mL, P=0.02) compared with nontreated patients. Perihematoma and ipsilateral hemispheric CBF were similar in both groups. A multivariate linear regression model revealed that statin use and hematoma volumes were independent predictors of acute edema volumes. Statin use does not affect CBF in ICH patients. Statin use, along with hematoma volume, are independently associated with increased perihematoma edema volume.     

Relationship Between Temperature, Hematoma Growth, and Functional Outcome After Intracerebral Hemorrhage

Background

Fever and hematoma growth are known to be independent predictors of poor outcome after intracerebral hemorrhage (ICH). We sought to assess the distribution of temperature at different stages in relation to hematoma growth and functional outcome at 90 days in a cohort of ICH patients.

Methods

Data of patients registered in the Virtual International Stroke Trials Archive—ICH were analyzed. Temperatures at baseline, 24, 48, 72, and 168 h were assessed in relation to the hematoma growth and functional outcome at 90 days. We calculated the daily linear variation of each subject’s temperature by subtracting 37 °C from the maximal daily recorded temperature (delta-temperature). We used logistic regression and mixed-effects models to identify factors associated with hematoma growth, poor outcome, and temperature elevation after ICH.

Results

303 patients were included in the analysis. The average age was 66 ± 12 years, 200 (66 %) were males, median admission NIHSS was 13 [Interquartile range (IQR), 9–18), median GCS was 15 (IQR, 14–15). Hematoma growth occurred in 22 % and poor functional outcome at 90-days occurred in 41 % of the patients. Cumulative delta-temperature at 72 h was associated with hematoma growth; age, ICH score, hematoma growth, and cumulative delta-temperature at 168 h were associated with poor outcome at 90 days. Factors associated with fever in mixed-models were day after onset of ICH, hypertension, base hematoma volume, intraventricular-hemorrhage, pneumonia, and hematoma growth.

Conclusions

There is a temporal and independent association between fever and hematoma growth. Fever after ICH is associated with poor outcome at 90 days. Future research is needed to study the mechanisms of this phenomenon and if early protocols of temperature modulation would be associated with improved outcomes after ICH.     

Prior statin and short‐term outcomes of primary intracerebral hemorrhage: From a large‐scale nationwide longitudinal registry

IntroductionThe relationship between statins and intracerebral hemorrhage outcomes is unclear.AimWe aimed to compare the in‐hospital mortality and evacuation of intracranial hematoma rates in patients with primary intracerebral hemorrhage between prior statin users and nonusers.ResultsThe final study population included 66,263 patients. Multivariable logistics analyses showed that prior statin use was not associated with in‐hospital mortality for primary intracerebral hemorrhage (adjusted odd ratio 0.78, 95% CI 0.61–1.01), but reduced the proportion of patients undergoing evacuation of intracranial hematoma (adjusted odd ratio 0.70, 95% CI 0.61–0.82). Propensity score matching analyses yielded similar results.ConclusionPrior statin use was not associated with in‐hospital mortality but did reduce evacuation of intracranial hematoma rates.